Latrobe family doctor bucks trend of mega-practices

December 28, 2012 5:00 AM

By Steve Twedt Pittsburgh Post-Gazette

The "family" part of Grosso Family Medicine works both ways.

Kevin Grosso, the physician, and Michelle Grosso, his wife and a registered nurse, provide standard family medical care for their Latrobe-area patients from age 6 up. Everything from routine physicals to blood tests and echocardiograms, they've got it covered.

But Grosso Family Medicine is also, literally, the Grosso family. Kevin and Michelle are the only two caregivers -- in fact, the only two employees -- for the practice that has leased office space just down the hill from Saint Vincent College.

When you call the office, either Kevin or Michelle will answer. If your child spikes a fever late Saturday night, Dr. Grosso -- and not a fellow physician in a call group -- will be responding. And two weeks each year, Christmas week and a week during summer, the office closes completely, although they remain reachable by phone.

A TIDE OF CHANGE

Sixth in a series on how our economy has transformed since bottoming out a generation ago.

Our regional economy barely resembles the one from 30 years ago. A full generation has passed since January 1983, when the southwestern Pennsylvania economy was at its nadir and unemployment was at its all-time peak.

Saturday: Of the top 25 retail banks in the seven-county Pittsburgh region in the 1980s, just nine are in business today. Although they survived the 1983 collapse, they couldn't survive regulatory changes and the most recent financial meltdown.

They describe their practice as "faith-based" and their website features Biblical scriptures, although they welcome patients of all religions and cultures. "That's who we are," said Dr. Grosso. From their perspective, being open about their faith is another way for their patients to know more about them, although no one should expect to hear a sermon during an office visit. "We don't pray with our patients. We pray for our patients," he said.

A generation or more ago, this Marcus Welby model of the small, independent physician -- as much friendly neighbor as caregiver -- may have seemed the norm. But that romantic notion has come under increasing financial and regulatory pressure the past 30 years and, many believe, may be on its way to extinction.

For years now, the trend has been for hospitals and health systems to buy physician practices and thus lock in patient referrals. Physicians, a notoriously independent-minded lot, may have resisted at first, but it seems each year brings new incentives to sign the contract: either the initial big paycheck, the regular hours, job security, help paying for the latest technology or simply having someone else handle the insurance paperwork.

As sole owners and operators of their practice, the Grossos -- in addition to the primary task of taking care of their patients -- also fulfill the duties of office manager, inventory manager, stock room supplier, accounts receivable manager and administrative assistant.

Earlier this month, when the server belonging to the vendor who manages their electronic health records broke down, the couple had to rely on paper patient records during the day, then stay after closing to transcribe those records into digital form. That meant arriving home to their three young adult children at 10 or 11 at night. "When things go wrong," said Mrs. Grosso, "we have to stay and take care of it."

Running the small, independent practice "takes more time than we thought it would," acknowledged Dr. Grosso. "It takes a lot of time and it takes a lot of time to get it right. That caught us by surprise."

But they believe the sacrifice is worth it because they think that's the way patients should be treated. "We're fully committed to it," Dr. Grosso said.

Dr. Grosso, 45, formerly was under contract with a large health system practice and was bothered by what he saw as a growing emphasis on boosting volume -- treating as many patients as possible to maximize revenues. The practice group he was part of, with about 10 attending and resident physicians, "would go through literally hundreds" of patients daily, he said. "I could see a patient in the office for an initial work up and I may not have contact with that patient again for a year."

Grosso Family Medicine sees 20 to 24 patients a day, every one of them treated by Dr. Grosso. They know their patients, and sometimes their patients' extended families as well.

Where now he sees new patients for a minimum 45-minute interview, "I was never given 45 minutes with a patient before. I may get 20 minutes." In that extra 25 minutes, Dr. Grosso said, he gets a fuller picture of the patient, and the parts of their life that could affect their health. Do they have a support network? Any hobbies, which could reduce stress?

Similarly, Mrs. Grosso, who is 44, said her former work as an emergency room nurse left little opportunity to get to know patients. Once the wound was stitched, they were out the door. "Now I can interact with the patients when I want or how I want."

She knows to ask about their grandchildren, and will notice if their mood seems down since the last visit.

Dr. Grosso said their practice has grown faster than they expected since it opened in June 2011, and they expect to reach their target of 1,700 to 2,000 patients in the next two years. "I would be afraid to do more than that and practice medicine the way I want to practice it."

The challenges are out there, though.

As hospitals and health systems expand and buy up practices, there's the risk of being cut out of exclusive networks. Reimbursements for government programs such as Medicare and Medicaid are diminishing, adding additional financial pressure. Dr. Grosso noted that one Medicaid plan pays a flat $9 per month for each beneficiary. Yet one test for strep throat costs him $17, plus the time he could be treating other patients.

"Each visit is going to be a $30 to $40 loss," he said. They accept Medicare and Medicaid, and most major insurance, he added, but there might come a day when they have to reconsider that "if I'm going to be able to pay the bills."

They expect things may smooth out in the next couple of years, now that the practice is getting established. Where at first they bought ads to attract new patients, more of their new business comes from word-of-mouth referrals.

Going it alone has its scary side -- "We're very extended financially," noted Dr. Grosso, "and every day we're not here, money is not being made" -- but they see their small practice as being more nimble than others, able to adjust to whatever changes in health care happen over the next 30 years.